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Professor Trisha Dunning is Inaugural Chair in Nursing at Deakin University and Barwon Health, Australia. She is an honorary Life Member of the Australian Diabetes Educators Association, a Vice President of the International Diabetes Federation and a distinguished Life Fellow of the Royal College of Nursing, Australia.

Preface xvi

Acknowledgements xviii

List of Abbreviations and Symbols xix

1 Diagnosing and Classifying Diabetes 1

Key points 1

What is diabetes mellitus? 2

Prevalence of diabetes 2

Classification of diabetes 3

Overview of normal glucose homeostasis 4

The metabolic syndrome in children and adolescents 7

Type 1 and Type 2 diabetes 8

Type 2 diabetes in Indigenous children and adolescents 15

Gestational diabetes 15

Example Information Sheet: Preparation for an oral glucose tolerance test 20

Screening for diabetes 21

Preventing Type 2 diabetes 22

Preventing Type 1 diabetes 25

Managing diabetes mellitus 25

Key points 25

Aims of management 27

Exercise/activity 29

Diabetes education 32

Complications of diabetes 33

Aim and objectives of nursing care of people with diabetes 34

Technology and diabetes management 36

A sobering final comment 38

References 38

2 Holistic Assessment, Nursing Diagnosis, and Documentation 44

Key points 44

Rationale 44

Holistic nursing 45

Care models 45

Characteristics of an holistic nursing history 47

Nursing history 49

Example Health Assessment Chart 50

Instruments to measure health status 54

Documenting and charting patient care 54

Care plans 55

Nursing responsibilities 56

Documentation by people with diabetes 57

References 58

3 Monitoring Diabetes Mellitus 60

Key points 60

Rationale 60

Introduction 61

Monitoring 1: Blood glucose 61

Key points 61

Blood glucose testing checklist 71

Monitoring 2: Urine glucose 73

Key points 73

Monitoring 3: Additional assessment 76

Self-care 80

The annual review 81

References 81

4 Nutrition, Obesity and Exercise 84

Key points 84

Rationale 84

The importance of good nutrition 85

Obesity 85

Overview of the pathogenesis of obesity 86

The significance of abdominal obesity 87

Nutrition, obesity and stress 88

Methods of measuring weight 88

Managing obesity and diabetes 90

Malnutrition and under-nutrition 90

Method of screening for dietary characteristics and problems 93

Principles of dietary management for people with diabetes 94

Goals of Dietary Management 97

Dietary management: obesity 98

Bariatric surgery 99

Complementary weight loss programmes 101

Factors associated with making dietary changes 101

Nursing responsibilities 102

References 107

5 Medicines Management 111

Key points 111

Introduction 112

Quality Use of Medicines (QUM) 112

Quality Use of Medicines and Diabetes 113

Oral Glucose-Lowering Medicines (GLM) 114

The incretin hormones 124

New medicines for type 2 diabetes 125

Medicine interactions 126

When should insulin be initiated in Type 2 diabetes? 128

Barriers to insulin therapy 132

Some strategies to overcome the barriers 132

Insulin therapy 133

Types of insulin available 134

Injection sites and administration 137

Mixing short- and intermediate-acting insulins 138

Commonly used insulin regimens 139

Interpreting morning hyperglycaemia 140

Continuous subcutaneous insulin infusion (CSII) 141

Continuous blood glucose sensors 142

Subcutaneous insulin sliding scales and top-up regimes 143

Uses of insulin infusions 145

Insulin allergy 147

Transplants 148

Stabilising diabetes 148

Stabilising diabetes in hospital 149

Community and outpatient stabilisation 150

Lipid-lowering agents 152

Monitoring lipid medicines 157

Antihypertensive agents 157

Antiplatelet agents 160

Medication safety, adherence and medication self-management 161

Enhancing medication self-care 163

Example protocol for outpatient stabilisation onto insulin 166

References 167

6 Hypoglycaemia 174

Key points 174

Rationale 174

Introduction 175

The counter-regulatory response 176

Definition of hypoglycaemia 178

Recognising hypoglycaemia 180

Counter-regulatory hormonal response to hypoglycaemia 181

Causes of hypoglycaemia 181

Preventing and managing hypoglycaemia 182

Hypoglycaemic unawareness 183

Prevalence of hypoglycaemic unawareness 183

Nocturnal hypoglycaemia 184

Relative hypoglycaemia 187

Medicine interactions 187

Objectives of care 188

Treatment 188

Prolonged hypoglycaemia 189

Patients most at risk of hypoglycaemia 190

Psychological effects of hypoglycaemia 191

Consequences of hypoglycaemia 192

Guidelines for administering glucagon 193

Adverse reactions 194

References 194

7 Hyperglycaemia, Acute Illness, Diabetic Ketoacidosis (DKA), Hyperosmolar Hyperglycaemic States (HHS), and Lactic Acidosis 198

Key points 198

Rationale 199

Prevention: proactively managing intercurrent illness 199

Self-care during illness 201

Hyperglycaemia 201

Diabetic ketoacidosis (DKA) 203

Brittle diabetes and hyperglycaemia 210

Euglycaemic DKA 210

Hyperosmolar Hyperglycaemic States 211

Presenting signs and symptoms 212

Lactic acidosis 213

Lactic acidosis associated with Metformin 215

References 216

8 Long-Term Complications of Diabetes 218

Key points 218

Introduction 219

Pathophysiology of diabetes complications 219

Cardiovascular disease and diabetes 221

Key points 221

Rationale 222

Medicines and cardiovascular disease 223

Complementary medicines (CAM) 226

Other management considerations 227

Mental health and cardiovascular disease 228

Nursing responsibilities 229

Telephone coaching 233

Cerebrovascular disease 233

Signs and symptoms 234

Diabetes and eye disease 235

Key points 235

Rationale 235

Introduction 235

Risk factors for retinopathy 236

Diabetes and renal disease 241

Key points 241

Introduction 241

Stages of chronic kidney disease 241

Risk factors for renal disease 242

Renal failure 243

Renal disease and anaemia 245

Diet and renal disease 245

Renal disease and older people 247

Kidney biopsy 247

Renal dialysis 247

Objectives of care 249

Nursing responsibilities 250

Commencing CAPD in patients on insulin 250

Educating the patient about CAPD 251

Supportive care 252

Renal disease and herbal medicine (see also Chapter 19) 252

Peripheral and autonomic neuropathy 253

Key points 253

Introduction 253

Vascular changes 254

Infection 255

Diabetes-related peripheral neuropathy 257

Other pain management strategies 258

Stages of peripheral neuropathy 259

Risk factors for developing foot problems 259

Objectives of care 260

Nursing responsibilities 260

Classification of foot ulcers 262

Wound management 262

Wound management techniques under study 264

Rehabilitation 264

Autonomic neuropathy 265

Key points 265

Introduction 265

Diagnosis and management 267

Nursing care 268

References 269

9 Management During Surgical and Investigative Procedures 277

Surgical procedures 277

Key points 277

Rationale 277

Introduction 278

Children with diabetes undergoing surgical procedures 279

Older people with diabetes and surgical procedures 280

Aims of management 280

Preoperative nursing care 281

Major procedures 284

Postoperative nursing responsibilities 286

Minor procedures 287

Insulin pump therapy in patients undergoing surgery 288

Emergency procedures 289

Bariatric surgery 290

Investigative procedures 290

Key points 290

Rationale 290

The objectives of care 291

General nursing management 291

Eye procedures 292

Complementary therapies and surgery and investigative procedures 295

Preoperative phase 295

Postoperative phase 296

Implications for nursing care 297

References 297

Example Instruction Sheet 2(a): Instructions for people with diabetes on oral glucose-lowering medicines having procedures as outpatients under sedation of general anaesthesia 298

Example Instruction Sheet 2(b): Instructions for people with diabetes on insulin having procedures as outpatients under sedation or general anaesthesia 299

10 Conditions Associated with Diabetes 300

Key points 300

Introduction 300

Enteral and parenteral nutrition 301

Aims of therapy 301

Routes of administration 302

Choice of formula 304

Nursing responsibilities 304

Diabetes and cancer 306

Management 307

Objectives of care 308

Nursing responsibilities 309

Managing corticosteroids in people with cancer 310

Complementary therapies and cancer 311

Smoking, alcohol, and illegal drug use 312

Smoking 312

Nicotine addiction 314

Assisting the person to stop smoking 315

Medicines to support smoking cessation 317

Alcohol addiction 317

Illegal drug use 319

Effects on diabetes 321

Interactions with medicines 322

Management issues 322

Brittle diabetes 323

Introduction 323

Causes of brittle diabetes 324

Management 324

Oral health and diabetes 325

Introduction 325

Causal mechanisms 326

Management 326

Diabetes and liver disease 327

Introduction 327

Managing people with diabetes and liver disease 328

CAM medicines 329

Haemochromatosis 329

Iron overload 330

Management 330

Diabetic mastopathy 330

Diagnosis 330

Management 331

Diabetes and coeliac disease 331

Signs and symptoms 332

Diagnosis 332

Management 333

Cystic fibrosis-related diabetes 333

Diagnosis 334

Signs and symptoms 335

Management 335

Sleep disturbance and diabetes 335

Diagnosis 336

Management 337

Diabetes and tuberculosis 337

Management 337

Diabetes and HIV/AIDS 338

Management 338

Diabetes and hearing loss 339

Causes of hearing loss 339

Management 340

Diabetes and musculoskeletal diseases 341

Management 342

Corticosteroid and antipsychotic medications and diabetes 342

Key points 342

Introduction 342

Management 344

Antipsychotic medicines 345

Diabetes and driving 346

Prevalence of and risk factors for driving crashes 346

Diabetes-related effects on driving 349

Hypoglycaemia effects on driving 352

Strategies to enhance driving safety 353

Information for people with diabetes to help them drive safely 354

Diabetes and fasting for religious observances 355

Education and counselling 356

References 356

11 Diabetes and Sexual and Reproductive Health 365

Key points 365

Rationale 365

Sexual health 366

Sexual development 367

Sexual problems 367

Possible causes of sexual difficulties and dysfunction 368

Sexuality and older people 369

Women 369

Men 370

Investigation and management 371

Medication management for ED 372

Non-pharmacological therapy 372

Complementary medicines for sexual problems (CAM) 373

Involving partners in ED management 374

Sexual counselling 374

The PLISSIT model 376

Role of the nurse 377

References 377

12 Diabetes in Older People 379

Key points 379

Rationale 380

Introduction 380

Determining functional status 386

Geriatric syndromes 388

Cognitive functioning 388

Depression and older people with diabetes 394

Dementia 394

Managing diabetes in older people 395

Management aims 395

Factors that affect management decisions 396

Guidelines for administering diabetes medicines with enteral feeds 401

Education approaches 402

Self-care 403

Factors that can affect metabolic control 404

References 414

13 Diabetes in Children and Adolescents 422

Key points 422

Rationale 422

Introduction 423

Managing children and adolescents with diabetes 425

Aspects of care that apply to both Type 1 and Type 2 diabetes in children and adolescents 425

Managing Type 1 diabetes 427

Managing childhood Type 2 diabetes 430

Medication self-management 431

Other conditions associated with diabetes 431

Complementary therapy use in children 432

Strategies for enhancing adherence during adolescence 433

Ketoacidosis in children 434

References 434

14 Women, Pregnancy, and Gestational Diabetes 438

Key points 438

Rationale 438

Polycystic ovarian syndrome 439

Pregnancy 442

Complications of pregnancy 446

Effects of diabetes on the baby 447

Longer term effects of maternal hyperglycaemia on the child 448

Gestational diabetes 448

Risk factors for gestational diabetes? 449

Managing gestational diabetes 450

Type 1 diabetes 451

Type 2 diabetes 452

Menopause and diabetes 452

Signs and symptoms of menopause 453

Managing the menopause 453

Contraception options for women with diabetes 454

Complementary approaches to managing the menopause 456

References 458

15 Psychological and Quality of Life Issues Related to Having Diabetes 463

Key points 463

Rationale 464

Introduction 464

Depression 469

Symptoms of depression 470

Maintaining mental health and managing depression 470

Screening for psychological distress and depression 472

Antipsychotic medicines and diabetes 473

Type 1 diabetes 473

Type 2 diabetes 474

Compliance/adherence/concordance 475

Psychological distress and cardiovascular disease 476

Quality of life 478

References 479

16 Diabetes Education 483

Key points 483

Rationale 484

Introduction 484

Learning styles 486

Education and other theories/models 489

Communication – the central element of effective teaching and learning 492

Teaching: an art and a process 494

Health literacy 495

Survival skills 498

Sample diabetes education record chart 499

Empowerment 501

Special issues 502

The nurses’ role in diabetes education 502

Insulin administration 504

Guidelines for teaching people about insulin delivery systems 504

Documenting diabetes education 505

Examples instruction sheets 505

Example Instruction Sheet 3: How to draw up insulin from one bottle 505

Example Instruction Sheet 4: How to draw up insulin from two bottles

(usually a short/rapid acting and an intermediate acting insulin) 506

Example Instruction Sheet 5: How to give an insulin injection using syringes or insulin pens 506

Example Instruction Sheet 6a: Managing your diabetes when you are ill: patients with Type 1 diabetes 506

Example Instruction Sheet 6b: Managing your diabetes when you are ill: patients with Type 2 diabetes 508

Evaluating diabetes education 509

References 511

17 Nursing Care in the Emergency, Intensive Care, Outpatient Departments, Community and Home-Based Care and Discharge Planning 516

Key points 516

Community, practice and home care nurses are in an ideal position to deliver preventative health care education 516

Rationale 516

The emergency department 517

Intensive Care (ICU) 519

The outpatient department 519

Community, Practice Nursing, and Home-Based Care 520

Introduction 520

How to obtain advice 521

General points 521

Disposing of sharps in the home situation 527

Storing insulin 528

Practice nurses 528

Discharge Planning 529

Key points 529

References 530

18 Managing Diabetes at the End of Life 532

Key points 532

Introduction 533

Palliative care and diabetes 534

Key issues in palliative and end of life care 534

The end of life process 538

Key management considerations for managing diabetes at the end of life 540

Glycaemic targets 541

Blood glucose monitoring 541

Hyperglycaemia 542

Hypoglycaemia 542

Medicine management 543

Type 1 diabetes 543

Type 2 diabetes 544

Nutrition and hydration 545

Diabetogenetic medicines 546

Managing corticosteroid-induced diabetes in palliative care patients 547

Antipsychotic medicines 547

Supporting family/carers 548

Withdrawing treatment 548

Diabetes education 549

References 549

19 Complementary and Alternative Therapies 552

Key points 552

Rationale 552

Introduction 553

CAM philosophy 555

Integrating complementary and conventional care 556

Can complementary therapies benefit people with diabetes? 558

Spirituality 561

CAM and surgery 561

Herb/medicine interactions 567

How can complementary therapies be used safely? 568

Nursing responsibilities 569

Identifying quality health information on the Internet 570

References 572

Index 575

“Care of People with Diabetes is an essential guide to the care and management of people with diabetes mellitus, with particular emphasis on the acute care setting. Written by an experienced clinical nurse specialist with extensive knowledge of evidence-based diabetes care, this fully updated fourth edition serves as an essential companion to clinical practice for nurses and healthcare professionals.”  (Newbooks.lib, 9 September 2014)

“However, whilst the book is a nursing manual, it would be a useful resource for any health professional involved in the care of people with diabetes.”  (Journal of Diabetes Nursing, 1 June 2014)